Browsing by Author "Fernando, A.D."

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Association of attachment with parents and abusive experiences during childhood
(Sri Lanka Medical Association, 2016) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.S.
INTRODUCTION: Improving parent-child attachment is considered to be an effective intervention in preventing child abuse. OBJECTIVES: This study is aimed at determining the association between parent-child attachment and experience of abuse during childhood. METHOD: A cross sectional analytical study was conducted among a representative sample of 1479 schooling young adults aged 18-20 years in Gampaha District, selected using a multi-stage cluster sampling method. Experience of abuse during childhood were determined using the self-administered locally validated tool SICAST-R. Parent-child attachment was determined using Inventory of Parent and Peer Attachment (IPPA), a self-administered tool, which measures the attachment to parents during childhood in the dimensions of communication, trust and alienation. RESULTS: The prevalence rates for abusive experience during childhood were 45.4% (95% CI=42.9–47.9), 9.1% (95% CI=7.6-10.5) and 27.9% (95% CI=25.7–30.2) for physical, sexual and emotional abuse respectively. All three dimensions that describe the attachment with the mother were significantly associated with being physically (poor trust:OR=3.71, 95% CI=1.52-9.05; poor communication: OR=1.72, 95%CI=0.89-3.35; presence of alienation: OR=2.63, 95%CI=1.72-4.00), sexually (poor trust: OR=3.62, 95%CI=1.07-12.25; poor communication :OR=2.44, 95% CI=1.01-5.92; presence of alienation: OR=3.89, 95% CI=2.22-6.81) and emotionally (poor trust: OR=6.56, 95% CI=2.88-14.91; poor communication: OR=3.19, 95% CI=1.78-5.71; presence of alienation: OR=3.32, 95% CI=2.21-4.98) abused during childhood. Similarly, aall three dimensions that describe the attachment with the father were significantly associated with being physically (poor trust: OR =3.16, 95%CI = 1.92-5.19; poor communication: OR=2.72, 95%CI=1.57-4.72; presence of alienation: OR=2.53, 95%CI=1.80-3.56), sexually (poor trust: OR=2.49, 95%CI = 1.18-5.29; poor communication: OR = 3.28, 95%CI = 2.27-4.74; presence of alienation: OR = 2.55, 95%CI = 1.54-4.22) and emotionally (poor trust: OR = 3.29, 95%C I= 2.00-5.39; poor communication:OR = 4.47, 95%CI = 2.05-9.73; presence of alienation: OR=3.21, 95%CI = 2.30-4.48) abused during childhood. CONCLUSIONS: Poor attachment with parents is associated with abusive experience during childhood. Public Health Programmes should focus on improving parent-child attachment.
Child abuse and neglect; who gets abused and who abuses them?
(Sri Lanka Medical Association, 2005) Fernando, A.D.; Karunasekera, K.A.W.; Fernando, L.; Samarasekera, A.
OBJECTIVES: To study the socio-demographic characteristics of victims of child abuse and characteristics of the perpetrators. Study Design: A descriptive study. METHOD: A prospective study of 112 victims of child abuse presenting to the University Paediatric Unit, Ragama from January 2000 to August 2004. The study evaluated characteristics of victims and perpetrators. Ethical approval was obtained. Data Analysis: Epi info version 6. RESULTS: Mean age of the victims was 9.7 years. 79% were females. Ethnicity-91% Singhalese, 5%Muslims and 4%Tamils. 82% resided in Gampaha District. Education of father and mother respectively - 5% and 11%-not attended school, 32% and 34%-primary education, 52% and 50%-ordinary level and 11% and 9%-advanced level. Social class -46%-unskilled, 26%-poorly skilled, 18%-skilled and 10%-lesser professionals. Monthly income (Rs.) -6% <2000, 37% 2000-5000, 33% 5000-10,000 and 24% >10,000. Marital status- 64%-married, 27%-divorced, 6%-unmarried and living together, 3%-single. Amongst married parents, 20% of mothers and 6% of fathers were abroad. Caregiver to the victim- 47%-both parents, 15%-mother, 15%-father, 14%-relatives and 9%-others. Consumption of alcohol by father -59%. Characteristics of perpetrators- 98% were known to the victims and in 24% the perpetrator was the father. Number of perpetrator/s- 86%-one, 5%-two, 5%-three, 4%-more than 3. Perpetrator being drunk at the tine of abuse in 31%. Amongst sexually abused, 26% were acts of incest. Of those 70% by father. CONCLUSIONS: The most vulnerable victims of abuse are shown to be 10-year-old females. Majority came from low social and educational backgrounds, In <5Q%, both parents cared for the child. 98% of perpetrators were trusted persons and in nearly a quarter it was the father.
Child abuse:time for action
(Sri Lanka Medical Association, 1996) Fernando, A.D.; de Silva, D.G.H.
No Abstract Available
A Child with Morquio syndrome and mixed mitral valve disease
(Sri Lanka Medical Association, 2008) Mettananda, D.S.G.; Fernando, A.D.
No Abstract Available
Correction to: Prenatal attachment: Using measurement invariance to test the validity of comparisons across eight culturally diverse countries
(Springer, 2021) Foley, S.; Hughes, C.; Murray, A.L.; Baban, A.; Fernando, A.D.; Madrid, B.; Osafo, J.; Sikander, S.; Abbasi, F.; Walker, S.; Van, T.V.; Luong-Thanh, B.Y.; Tomlinson, M.; Fearon, P.; Ward, C.L.; Valdebenito, S.; Eisner, M.
[This corrects the article Archives of Women's Mental Health.2021; 24(4): 619-625] Erratum for Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries
Cultural adaptation, translation and validation of the ISPCAN Child Abuse Screening Tool - Retrospective Version (ICAST-R) for young adults in Sri Lanka
(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.
The aim of the present study was to adapt and validate the ISPCAN child abuse screening tool-retrospective version (ICAST-R) in Sri Lanka with a view to investigating the experiences of physical, sexual and emotional abuse during childhood. The adaptation was performed using qualitative research methods with young adults, parents, teachers, and a multidisciplinary group of experts. The translation to Sinhala (the local Sri Lankan dialect) was carried out by a nominal group technique. A multidisciplinary team of experts assessed the Sinhala ICAST-R (SICAST-R) for its content validity. Moreover, acceptability, reliability and construct validity were determined by conducting a validation study among 200 schooling young adults. The principal component analysis (PCA) technique was used to assess the construct validity. Response rates for each item were taken as evidence of acceptability. The internal consistency was assessed by Cronbach's alpha, and test-retest reliability after two weeks was assessed using Cohen's kappa coefficient. The adaptation of ICAST-R included the introduction of an objective manner by which to measure severity of abuse and the inclusion of a set of questions regarding help-seeking behavior following physical and emotional abusive experiences. The SICAST-R showed adequate content validity and high acceptability, with response rates ranging from 90.3% to 99.5%. The minimum Cohen's kappa coefficient was 0.76, indicating good test-retest reliability. The internal consistency (Cronbach's alpha) for the total tool was 0.708, with the three constructs being 0.398, 0.844 and 0.637 for physical, sexual and emotional abuse, respectively. The PCA demonstrated good reproducibility for sexual and emotional abuse with the hypothesized structure. Overall, the SICAST-R showed adequate validity for the assessment of experiences of physical, sexual and emotional abuse during childhood among Sri Lankan young adults.
Developing pathways for a safer childhood
(Sri Lanka College of Paediatricians, 2012) Fernando, A.D.
No Abstract Available
Do schools promote violence in Sri lanka?
(Sri Lanka Medical Association, 2004) Fernando, A.D.
No Abstract Available
Efficacy of a dengue vaccine candidate (TAK-003) in healthy children and adolescents two years after vaccination
(University of Chicago Press, 2022) López-Medina, E.; Biswal, S.; Saez-Llorens, X.; Borja-Tabora, C.; Bravo, L.; Sirivichayakul, C.; Vargas, L.M.; Alera, M.T.; Velásquez, H.; Reynales, H.; Rivera, L.; Watanaveeradej, V.; Rodriguez-Arenales, E.J.; Yu, D.; Espinoza, F.; Dietze, R.; Fernando, L.; Wickramasinghe, P.; Moreira Jr, E.D.; Fernando, A.D.; Gunasekera, D.; Luz, K.; da Cunha, R.V.; Tricou, V.; Rauscher, M.; Liu, M.; LeFevre, I.; Wallace, D.; Kosalaraksa, P.; Borkowski, A.; TIDES study group.
BACKGROUND: Takeda's dengue vaccine is under evaluation in an ongoing Phase 3 efficacy study; we present an update after 2 years. METHODS: 20,099 children (4-16 years old) were randomized to receive two doses of TAK-003 or placebo three months apart and are under long-term febrile surveillance to detect dengue by serotype-specific RT-PCR. (NCT02747927). RESULTS: Cumulative efficacy against dengue over ~27 months since first dose was 72.7% (95% CI: 67.1 - 77.3), which included efficacy of 67.0% (95% CI: 53.6 - 76.5) in dengue-naïve and 89.2% (82.4 - 93.3) against hospitalized dengue. In the second year after vaccination, a decline in efficacy was observed [56.2% (42.3 - 66.8)] with the largest decline in 4 - 5 year-old children [24.5% (-34.2 - 57.5)]; efficacy was 60.6% (43.8 - 72.4) in 6 - 11 year and 71.2% (41.0 - 85.9) in 12 - 16 year age groups. As TAK-003 efficacy varies by serotype, changes in serotype dominance partially contributed to the efficacy differences in year by year analysis. No related serious adverse events occurred during the second year. CONCLUSION: TAK-003 demonstrated continued benefit independent of baseline serostatus in reducing dengue with some decline in efficacy during the second year. Three-year data will be important to see if efficacy stabilizes or declines further. KEYWORDS: Dengue; TAK-003; efficacy; immunogenicity; persistence; safety; vaccine.
Evidence for Better Lives Study: a comparative birth-cohort study on child exposure to violence and other adversities in eight low- and middle-income countries - foundational research (study protocol)
(BMJ Publishing Group Ltd, 2020) Valdebenito, S.; Murray, A.; Hughes, C.; Băban, A.; Fernando, A.D.; Madrid, B.J.; Ward, C.; Osafo, J.; Dunne, M.; Sikander, S.; Walker, S.P.; Thang, V.V.; Tomlinson, M.; Fearon, P.; Shenderovich, Y.; Marlow, M.; Chathurika, D.; Taut, D.; Eisner, M.
Introduction: Violence against children is a health, human rights and social problem affecting approximately half of the world's children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries-Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam-to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers' biological stress markers and subjective well-being. Methods and analyses: EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. Ethics and dissemination: The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project. Keywords: Child protection; Community child health; EPIDEMIOLOGY; MENTAL HEALTH; Prenatal diagnosis.
Impact of corticosteroid therapy on lifestyles in asthmatic children from Sri lanka
(Indian Pediatrics, 2010) Karunasekera, K.A.W.; Fernando, A.D.; Jayasinghe, C.Y.
This study was conducted to ascertain the impact of inhaled corticosteroids therapy (ICS) in alleviation of lifestyle restrictions in 200 asthmatic children. 90 children on ICS were reviewed at 3 months. Restrictions on bathing, food, play activities and school attendance were found in <70%. These were not related to asthma severity. Following ICS, reduction in symptoms, hospital admissions, outpatient visits and nebulizations were noted between 67% -73%. Restrictions on bathing, food, play activities and school attendance had been waived off in 23% -55%. We conclude that ICS significantly alleviated symptoms and lifestyle restrictions. However, the reduction on lifestyle restrictions was less than symptom control.
The Impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries
(Elsevier/North-Holland Biomedical Press., 2021) Brown, R.H.; Eisner, M.; Walker, S.; Tomlinson, M.; Fearon, P.; Dunne, M.P.; Valdebenito, S.; Hughes, C.; Ward, C.L.; Sikander, S.; Osafo, J.; Madrid, B.; Baban, A.; Van Thang, V.; Fernando, A.D.; Murray, A.L.
BACKGROUND: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage. KEYWORDS: Adverse childhood experiences; Birth cohort; Depressive symptoms; Maternal-foetal-attachment; Prenatal.
Infantile Cronkhite Canada syndrome
(Dr. K. C. Chaudhuri Foundation, co-published by Springer India, 1997) de Silva, D.G.H.; Fernando, A.D.; Law, F.M.; Premarathne, M.; Liyanarachchi, D.S.
Since 1955, numerous cases of Cronkhite-Canada syndrome have been reported in adults. We present here the first Asian report of the infantile Cronkhite-Canada syndrome. While the prognosis in adults is variable, in children, it is less optimistic.
The Intergenerational effects of intimate partner violence in pregnancy: mediating pathways and implications for prevention.
(Sage Publications, 2020) Murray, A. L.; Kaiser, D.; Valdebenito, S.; Hughes, C.; Baban, A.; Fernando, A.D.; Madrid, B.; Ward, C. L.; Osafo, J.; Dunne, M.; Sikander, S.; Walker, S.; Van Thang, V.; Tomlinson, M.; Eisner, M.
Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal-fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV
Juvenile victimisation in a group of young Sri Lankan adults
(Sri Lanka Medical Association, 2009) Fernando, A.D.; Karunasekera, W.
OBJECTIVE: To study the prevalence of juvenile victimisation in a group of young adults. METHOD: A juvenile victimisation questionnaire was distributed among 1322 Sri Lankan undergraduates. The questionnaire consisted of different modules (child maltreatment, conventional crime, peer-sibling victimisation, indirect victimisation, introduction to substances and parental deprivation). RESULTS :The response rate was 90%. The mean age of the cohort was 21.8 years. 59% were females. 44% and 36% had experienced sexual and physical maltreatment respectively. In both categories males were affected more than females (p < 0.001). Physical abuse had commonly taken place at school (51%) and home (40%). Witnessing violence at home was the highest form of indirect victimisation (66%). 10% were introduced to substances in childhood. Usage of substances (cigarettes, alcohol and drugs) was significantly higher in children whose fathers used substances compared to children whose fathers did not (p < 0.001). CONCLUSION: Many children in Sri Lanka are exposed to victimisation. They seem to suffer these in the very environments that should be nurturing and protecting them.
Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4·5-year results from a phase 3, randomised, double-blind, placebo-controlled trial
(Elsevier, 2024) Tricou, V.; Yu, D.; Reynales, H.; Biswal, S.; Saez-Llorens, X.; Sirivichayakul, C.; Lopez, P.; Borja-Tabora, C.; Bravo, L.; Kosalaraksa, P.; Vargas, L.M.; Alera, M.T.; Rivera, L.; Watanaveeradej, V.; Dietze, R.; Fernando, L.; Wickramasinghe, V.P.; Moreira, E.D.; Fernando, A.D.; Gunasekera, D.; Luz, K.; Oliveira, A.L.; Tuboi, S.; Escudero, I.; Hutagalung, Y.; Lloyd, E.; Rauscher, M.; Zent, O.; Folschweiller, N.; LeFevre, I.; Espinoza, F.; Wallace, D.
BACKGROUND: About half of the world's population lives in dengue-endemic areas. We aimed to evaluate the long-term efficacy and safety of two doses of the tetravalent dengue vaccine TAK-003 in preventing symptomatic dengue disease of any severity and due to any dengue virus (DENV) serotypes in children and adolescents. METHODS: In this ongoing double-blind, randomised, placebo-controlled trial, we enrolled healthy participants aged 4-16 years at 26 medical and research centres across eight dengue-endemic countries (Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). The main exclusion criteria were febrile illness (body temperature ≥38°C) at the time of randomisation, hypersensitivity or allergy to any of the vaccine components, pregnancy or breastfeeding, serious chronic or progressive disease, impaired or altered immune function, and previous receipt of a dengue vaccine. Participants were randomly assigned 2:1 (stratified by age and region) using an interactive web response system and dynamic block assignment to receive two subcutaneous doses of TAK-003 or placebo 3 months apart. Investigators, participants, and their parents or legal guardians were blinded to group assignments. Active febrile illness surveillance and RT-PCR testing of febrile illness episodes were performed for identification of virologically confirmed dengue. Efficacy outcomes were assessed in the safety analysis set (all randomly assigned participants who received ≥1 dose) and the per protocol set (all participants who had no major protocol violations), and included cumulative vaccine efficacy from first vaccination to approximately 4·5 years after the second vaccination. Serious adverse events were monitored throughout. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS: Between Sept 7, 2016, and March 31, 2017, 20 099 participants were randomly assigned (TAK-003, n=13 401; placebo, n=6698). 20 071 participants (10 142 [50·5%] males; 9929 [49·5%] females; safety set) received TAK-003 or placebo, with 18 257 (91·0%) completing approximately 4·5 years of follow-up after the second vaccination (TAK-003, 12 177/13 380; placebo, 6080/6687). Overall, 1007 (placebo: 560; TAK-003: 447) of 27 684 febrile illnesses reported were virologically confirmed dengue, with 188 cases (placebo: 142; TAK-003: 46) requiring hospitalisation. Cumulative vaccine efficacy was 61·2% (95% CI 56·0-65·8) against virologically confirmed dengue and 84·1% (77·8-88·6) against hospitalised virologically confirmed dengue; corresponding efficacies were 53·5% (41·6-62·9) and 79·3% (63·5-88·2) in baseline seronegative participants (safety set). In an exploratory analysis, vaccine efficacy was shown against all four serotypes in baseline seropositive participants. In baseline seronegative participants, vaccine efficacy was shown against DENV-1 and DENV-2 but was not observed against DENV-3 and low incidence precluded evaluation against DENV-4. During part 3 of the trial (approximately 22-57 months after the first vaccination), serious adverse events were reported for 664 (5·0%) of 13 380 TAK-003 recipients and 396 (5·9%) of 6687 placebo recipients; 17 deaths (6 in the placebo group and 11 in the TAK-003 group) were reported, none were considered study-vaccine related. INTERPRETATION: TAK-003 demonstrated long-term efficacy and safety against all four DENV serotypes in previously exposed individuals and against DENV-1 and DENV-2 in dengue-naive individuals. FUNDING: Takeda Vaccines. TRANSLATIONS: For the Portuguese, Spanish translations and plain language summary of the abstract see Supplementary Materials section.
Management of childhood meningitis
(State Pharmaceuticals Corporation, 1999) Fernando, A.D.
No abstract available
Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity
(Springer, 2022) Katus, L.; Foley, S.; Murray, A.L.; Thanh, B.Y.L.; Taut, D.; Baban, A.; Madrid, B.; Fernando, A.D.; Sikander, S.; Ward, C.L.; Osafo, J.; Marlow, M.; Toit, S.D.; Walker, S.; Van Vo, T.; Fearon, P.; Valdebenito, S.; Eisner, M.P.; Hughes, C.
Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.
Physical, sexual and emotional abuse during childhood: Experiences of a sample of Sri Lankan young adults
(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.
Abuse during childhood is a human tragedy leading to lifelong adverse health, social, and economic consequences for survivors. This descriptive, cross-sectional study aimed to determine the prevalence of childhood physical, sexual and emotional abusive experiences among students (aged 18-19 years) in a Sri Lankan district. Multistage cluster sampling was used to select a sample of 1500 students. Experiences of physical, sexual and emotional abuse and age at abuse, perpetrators, consequences and severity were assessed using a version of ISPCAN Child Abuse Screening Tool-Retrospective Version (ICAST-R) which was culturally adapted and validated by the authors for use amongst Sinhalese students. The prevalence of the various forms of abuse during childhood was as follows: physical: 45.4% (95% CI: 42.9-7.9); sexual: 9.1% (95% CI: 7.6-10.5); emotional: 27.9% (95% CI: 25.7-30.2). The corresponding percentages of individuals categorized as having experienced severe or very severe abuse were as follows, physical: 0.3% (2/672); sexual: 4.05% (3/135); emotional: 8.8% (36/412). Experience of physical abuse was more prevalent amongst male students (54.8% vs. 38.3%) as was emotional abuse (33.9% vs. 23.2%), whereas experience of sexual abuse was more prevalent amongst female students (11.5% vs. 6.4%). Parents and teachers were the commonest perpetrators of physical and emotional abuse. Most of the sexually abusive acts were committed by neighbors or strangers. Some physically abusive acts were more frequent at earlier ages than emotional and sexual abusive acts, which were more common in late adolescence. The results indicate the necessity of targeted interventions to address this public health issue.
Posterior reversible encephalopathy syndrome in a survivor of valproate-induced acute liver failure: a case report
(BioMed Central, 2013) Mettananda, S.; Fernando, A.D.; Ginige, N.
INTRODUCTION: Posterior reversible encephalopathy syndrome is an extremely rare radiological diagnosis that has not been reported previously in association with acute liver failure. CASE PRESENTATION: A 6-year-old Sri Lankan girl developed acute liver failure with severe hepatic encephalopathy due to sodium valproate. She was successfully treated medically with N-acetylcysteine and L-carnitine. During recovery she again developed features of encephalopathy and had repeated convulsions associated with moderate hypertension. The diagnosis of posterior reversible encephalopathysyndrome was made on clinical and radiological grounds and she showed a gradual improvement with control of blood pressure. CONCLUSIONS: This report adds to the evidence behind treatment of valproate-induced acute liver failure with N-acetylcysteine and L-carnitine and illustrates a rare but interesting association between acute liver failure and posterior reversible encephalopathy syndrome